Cariology; paediatric dentistry Dental care of six-year-old high-caries patients in relation to their cooperation

Varsio S, Vehkalahti M et al. Community Dent Health 1999; 16: 171–175

Caries prevention treatment in a group of high caries patients was more frequently given to those who cooperated better.

In a group of 3849 Helsinki 6-year-old children (96% of total), 7.2% had 4 or more carious teeth, and accounted for more than half the caries in the whole group. In the present study, 100 dental records from age 3 onwards were examined, for those 6-year-olds with the highest number of decayed teeth in each of the 7 administrative districts in Helsinki.

Based on the judgement of the dentists doing the treatment, 64 children were considered cooperative, and 33, uncooperative. The former experienced caries in a mean 8.9 df teeth by age 6, and the latter, in 10.1; respective mean numbers of dental visits were 5.6 and 7.8, and extractions or pulpotomies, 0.7 and 1.5; in both groups the mean number of primary molar fillings was 4.5, but only 1/4 of patients were treated with anaesthesia.

There was a tendency for cooperative patients to receive more preventive treatment than uncooperative patients (eg respective mean fluoride varnish applications were 1.1 and 0.7; P < 0.05), and to complete courses of treatment more frequently (60% v 40%). The authors comment that the treatment strategy for uncooperative patients should be directed more towards prevention and also the use of local anaesthesia where fillings are needed.

Oral medicine Clinical management of selected oral fungal and viral infections during HIV-disease

Reichert P A Int Dent J 1999;49:251–259

Highly-active antiretroviral therapy (HAART) has led to a marked decrease in oral lesions in HIV +ve and AIDS patients.

Researchers have distinguished 3 groups of oral infections in HIV patients. The first includes variations of opportunistic oral candidiasis, including hairy leucoplakia; the second includes mycobacterial and herpes infections and necrotizing stomatitis; and the third includes less frequent opportunistic infections, such as some mycoses and cytomegalovirus.

The CD4+ count is closely related to candidal infection and most patients are colonized. Treatment is important, particularly to prevent oesophageal spread. Various azole drugs are used for candidiasis in these patients, and there have been resistance problems which have been treated in several ways. Hairy leucoplakia does not usually require treatment and may resolve.

Where combination therapy (HAART) with antiretroviral drugs is employed, studies have shown reductions in the prevalence of oral lesions from 85% to as little as 8%. All these drugs have significant side-effects. The author lists recommendations for regular monitoring and effective therapy of symptomatic and asymptomatic HIV patients.

Fixed prosthodontics The periodontal response to cantilevered resin-bonded bridgework

Rashid S A, Al-Wahadni A M et al. J Oral Rehabil 1999; 26: 912–917

There were minor periodontal differences between abutment teeth and matched controls at reassessment 16-68 months later.

Over a 4 year period, 72 patients were given101 single-pontic single abutment resin-bonded bridges at a UK dental school. They were asked to return for a follow-up assessment, and 83% did so. Abutments had to be vital, either sound or with minimal proximal composite restorations, and periodontally stable with no bleeding on probing and no more than 4 mm attachment loss. Patients were shown how to use oral hygiene methods, including floss on abutments.

The mean duration of the 84 bridges was 44 months, and 78 had never debonded. Marginal adaptation was ideal in 72 bridges, and 6 each had a deficiency or resin excess. Mean Plaque Index was 1.15 on abutments, 0.73 on matched control teeth; respective mean Gingival Indices were 0.98 and 0.71, and probing depths, 2 mm and 1.8mm. The authors consider the differences clinically insignificant, and probably due to difficulties in pontic-related hygiene.

Preventive dentistry; cariology Effect of professional flossing with NaF or SnF2 gel on approximal caries in 13–16-year-old schoolchildren

Gisselsson H, Birkhed D et al. Acta Odont Scand 1999; 57: 121–125

Proximal caries was reduced by around 1/3 over a 3 year period with this intervention.

In a Swedish community, 317 12-year-old children were randomized to 3-monthly professional flossing with 3 gels: 1% NaF, 1% SnF2 or placebo; 37 did not complete the study, leaving 280. Every visit, a quadrant at a time was dried, gel was applied with a syringe to all proximal spaces from buccal and lingual aspects, and a waxed dental tape was used to floss each tooth surface about 10 times. Treatment time was about 10 minutes per visit.

At age 12, 97% of children had no proximal fillings and 60% had no dentine caries. Mean DFS in the 3 respective groups (as above) were 1.24, 0.89 and 0.95. By age 16 the respective caries increments were 2.78, 2.42 and 3.98. The difference between SnF2 and placebo was significant.

The results are similar to those of another professional flossing study using 1% chlorhexidine gel in which the same research group showed a 40% reduction of caries. It is also possible that the present placebo group had some caries reduction on account of the flossing, as the chlorhexidine study had a non-floss group which developed more caries than the placebo gel group. The authors also note the advantage of their simple techniques, which could be performed easily by a dental nurse in a school.